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THURSDAY, March 21, 2013 — Many trips to the hospital happen in a hurry. If you have a heart attack or are hurt in an accident, it's not likely you'll have time or even the ability to hail an ambulance taxi-style or direct its driver to the hospital of your choice. Most likely, you'll end up wherever the paramedics take you. And according to Consumer Reports, the hospital where you end up could score pretty low when it comes to patient safety.

In a report released today, the consumer-educating organization graded 2,031 hospitals across the country for safety based on readmissions, complications, communication, the overuse of CT scans and infection rates. You can find their full ratings database here. The average score was 49 out of 100, and nearly two-thirds of the 258 teaching hospitals in the country scored below that national average.

"I think we would all have high expectations that a teaching hospital would be leading the way in terms of infections, appropriate imaging, minimization of radiation, leading the way in communication, and things of that sort, and at least this snapshot does not support that, though there are several that are," said the director of the Consumer Reports Health Ratings Center, John Santa, MD.

Understanding Hospital Rankings

Hospital rankings are "sort of a hot topic right now," said Matt Austin, PhD, an instructor at the Johns Hopkins' Armstrong Institute for Patient Safety and Quality. "There are a growing number of entities involved in trying to share information with potential patients on quality and safety of care, specifically in hospitals."

Dr. Austin sees both benefits and disadvantages to hospital rankings for patients. As a benefit, "They do provide a more general picture of care in a hospital. Historically we've done a lot of quality and safety reporting at what would be an individual measure level," he said. This means measuring things like whether or not a heart attack patient received aspirin when he came into the hospital, or when he left, or other individual processes of care. This sort of reporting, Austin said, is "good for hospitals themselves but challenging for patients to synthesize all that information together to make a decision."

"The advantage of a ranking is that it's easier for patients to understand than individual measures and it provides a general picture of the quality of care at the hospital," he said.

A disadvantage to these rankings, however, is that they "can mask excellent or poor performance in individual care areas," Austin said. "You are sort of rolling everything up together into an overall ranking or score and not separating how a hospital is doing in individual areas. It may be doing well in some areas and poor in others, and a ranking can mask that."

It can also be unclear for patients what exactly each entity is measuring in a ranking, Austin said. U.S. News and World Report focuses on the best hospitals for patients with complicated conditions; Healthgrades looks at mortality in hospitals; and Consumer Reports and the Leapfrog Group (which also releases hospital safety grades) focus on patient safety — prevention of hospital-acquired infections, not leaving objects in the body during surgery, essentially what Austin called "the nuts and bolts of delivering care."

How Hospital Rankings Help Patients

While you might not be checking in the Internet from an ambulance, "there are lots of other times where people might have the time to do a little checking about what types of info is available," said Carol Cronin, founder and executive director of the Informed Patient Institute. A knee replacement, which allows for planning ahead, is a good example.

If you have the time, do your research, said Cronin. "What you're looking for when you're doing that advanced research is what you should avoid. You'll want to look in particularly for areas where the hospital may not do well, where they may be below average, and so it's a matter of trying to avoid bad care."

For a specific surgery, look for how often a hospital performs that surgery, Austin said. "Know the hospital's experience with that surgical procedure. The general trend is that hospitals that do more have better outcomes than hospitals that do less."

But what if you're the patient who wakes up in a hospital bed? "We've [Consumer Reports] tried to choose aspects of hospital performance that patients can do something about, for example when it comes to hospital-acquired infections most patients who are having surgery can participate in the sorts of things to prevent an infection after surgery."

Santa also hopes hospital rankings push hospitals to do better, which helps patients in the long-run. But for now, here are some things you can do while you're in the hospital to take an active role in your own health and safety.

Show interest in your imaging. One of the measures for safety Consumer Reports used is unnecessary imaging, often done with CT scans. Some CT scans are done with contrast (a dye that, taken intravenously or by mouth, allows doctors to see certain organs more clearly) while others are done without. "Almost always one or the other will suffice," said Santa. "Realize we're not saying they shouldn't have a CT scan, that's fine, what we're saying is that it turns out in many centers 20, 30, and 50 percent of chest CTs are done using both, with and without contrast." Excess CT scans can result it unnecessary and potentially harmful radiation exposure. Santa hopes that when a patient hears she or he will be getting two CT scans, one with and one without contrast, that patient will speak up and say, "‘I have heard there's a way this can be done with one,'" he said.

Pay attention to infection-prevention practice.Did your doctor wash his hands? Did that nurse use hand sanitizer? "Trust, but verify," said Cronin. "Be observant, ask questions politely, do your own cross-check like an airline pilot making sure you understand everything they tell you." In terms of preventing infection, watch out for catheters, Santa advised.

Check in about catheters. "There is an infection on the horizon called catheter-associated UTI, or CAUTI, these aren't being measured currently," said Santa. While catheters in the bladder keep the sheets clean (because patients without catheters might wet the bed due to incontinence), "they serve as a highway for bacteria in urine," he said. "In many instances it's [a catheter] not necessary and it's safer to go without one. But some patients are way too sick to object."

Enlist a health advocate. Given that patients aren't always awake or feeling their best when they're in the hospital, experts agree it's smart to have an advocate — usually a family member or friend — at the hospital.

Communicate and ask questions. Poor communication, especially at discharge, is one of the biggest reasons for hospital readmissions, said Santa. "There is insufficient communication when a patient is discharged around medications, next steps, who to call if there's a problem, what problems to watch for. That transition in care is just not happening well."

Overall, Santa, Austin, and Cronin agree patients should take an active role in their care, especially at the hospital. Don't be afraid to speak up and ask a question politely.

"The unfortunate thing with hospitals is they are very busy places, complicated places. Staff is often very overworked and, I don't think anyone is being negligent or wanting bad things to happen to patients. We just haven't designed systems in a way that can prevent these things from happening, said Austin. "We're all humans; we're going to make mistakes."

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